Newborn transition Assessment Flashcards
0
Q
What causes the change from fetal to neonatal circulation
A
Cessation of blood through the umbilical vessels and placenta
1
Q
How long can it take to transition from intrauterine to extrauterine life?
A
Up to 12 hours
2
Q
Fetal to neonatal circulation occurs simultaneously with what
A
Respiratory adaption
3
Q
When do the ductus venosus, foramen oval and the ductus ateriousus usually close
A
Within the first 24 hours of life
4
Q
What happens with cardiovascular adaption
A
Closure of the ductus venosus, foramen ovals and the ductus arteriousus
Shift to pulmonary circulation
5
Q
How long do you count apical impulse in a newborn
A
Full minute
6
Q
Where is PMI in a newborn
A
4th ICS to the left of the MCL
7
Q
Normal heart rate at birth
A
120-160
8
Q
In utero what’s a normal heart rate
A
Same as at birth. 120-160
9
Q
Normal capillary refill in a neonatal
A
Less than 3 seconds
10
Q
Average systolic and diastolic BP
A
60-80/40-50
11
Q
Why are femoral and bracial pulses palpated in neonatal
A
For symmetry, strength, and rate to provide info about change to adult circulation patterns
12
Q
Where do you palpate femoral pulse? Brachial?
A
Femoral- groin
Brachial? Inside of arm
13
Q
Why do you check both femoral and brachial pulse in neonatal
A
Coarctation of aorta
14
Q
Average blood volume in neonatal
A
300 ml
15
Q
What can late clamping of the cord lead to
A
Polycythemia
16
Q
Normal hemoglobin level in neonatal
A
14-24 g/dl
17
Q
Normal hematocrit in a neonatal
A
44%-64%
18
Q
Normal RBC in neonatal
A
4.8-7.1 /mm
19
Q
Normal WBC in neonatal
A
9,000-30,000 per mm
20
Q
Average platelets in neonatal
A
200,000-300,000
21
Q
What are the clotting factors
A
Factor II, VII, IX, and X
22
Q
Why are clotting factors low in neonatal
A
Lack of vitamin K
23
Q
If all the clotting factors are low at birth what could happen
A
Risk for bleeding
24
Breathing can be noted as early as ____ weeks gestation
11 weeks
25
Functioning lungs occurs after ____ weeks gestation
26
26
When is surfactant found in sufficient quantity
Around 35 weeks gestation
27
Fetal lung fluid is necessary for development does it increase or decrease with gestational age
It decreases
28
What helps with the surface tension in lungs
Surfactant
29
What could low amniotic fluid level mean
Could mean kidneys are not working correctly. Amniotic fluid stays in normal range by peeing so this would show kidneys are working
30
What does catecholamines do?
Increases the release of surfactant
31
Catecholamine surge prior to labor corresponds to what
Rapid drop in level of fluid in lung field
32
What stimulates the aortic and carotid chemoreceptors triggering the medulla initiation of receptors
Decrease oxygen and increase carbon dioxide concentration along with decrease pH
33
Surfactant increases the lungs ability to do what?
Fill with air
34
How does surfactant promote lung expansion
By preventing the complete collapsing of the alveoli with each expiration
35
Compression of the chest during vaginal birth forces ___of the fluid out of the lung fields
1/3
36
How does crying keep the alveoli open?
Creates positive intrathoracic pressure
37
What are three examples of sensory stimulation
Tactile
Visual
Auditory
38
Is there fluid in the lungs until the baby is born?
Yes
39
When does pulmonary vasodilation occur
As oxygen enters the lungs
40
What kind of sign is grunting after birth
Never a good sign
41
Respiratory adaptions are established within _____ after birth
1 minute
42
Babies are ____ breathers
Nose
43
Normal respirations for neonate
30-60 per minute
44
How should you count respirations
For a full minute because they may be irregular
45
Respirations should be noisy?
No they should be quiet
46
What does a baby use to breathe
Diaphragmatic and abdominal muscles
47
What are signs of respiratory distress
Nasal flaring, grunting, costal retractions and a rate less than 30 or more than 60
48
What is newborns ability to Maintain its temperature controlled by
External environmental factors and internal physiologic process
49
Heat loss as water evaporates from the skin
Evaporation
50
Transfer of body heat to surrounding air ( cold delivery room)
Convection
51
Transfer of heat to surface newborn is lying on
Conduction
52
Loss of heat through the air to a cooler surface (not in direct contact with the neonate)
Radiation
53
What do neonates have limited ability to do in order to generate heat?
Shiver
54
How is heat produced?
By the metabolism of brown fat and babies have less brown fat
55
Flexion of extremities, restlessness, and crying are examples of what
Voluntary muscle activity which is a thermogenic adaption
56
With cold stress, Increase glucose utilizes leads to?
Hypoglycemia
57
With cold stress, Increase oxygen consumption can lead to?
Metabolic acidosis
58
Signs of cold stress/hypothermia
Skin cool to touch, mottling of the skin, central cyanosis, decreased responsiveness, jittery, tachypnea
59
How is glucose stored for neonatal metabolic demands
Glucose is stored as glycogen
60
Due to rapid depletion of glycogen during the first 24 hours the glucose level will be between what ?
50-60 mg/ml
61
In utero _____ is stored for use in hemoglobin production after birth. If adequate will last till ____ month without needing supplement
Iron
| 5th
62
Will you hear bowel sounds as soon as baby is born?
No. Audible bowel sounds will be within first hour
63
Stomach capacity in neonate
30-90 ml
| About 3 oz
64
When is first meconium passed
12-24 hours
65
What could cause pink staining in diapers
Uris crystals
66
How long will,it take renal system to fully mature
1 year
67
____ ml of urine at birth
40
68
___-___ voids per day for first 2 days
2-6
69
___-____ voids per day after 48 hours
5-25
70
___-___ ml of urine per/kg/day
15-60
71
Color of urine
Odorless straw color
72
When do you start immunizations?
8 weeks
73
What three immunoglobulins does neonate depend on
IgA, IgG, IgM
74
Steps in initial assessment
```
Apgar score determined
Assess for gross abnormalities
Apply cord clamp
Obtain foot prints
Apply identification bands
Administer Vit K and eye prophylaxis
Promote bonding
```
75
How long is the first period of reactivity
Birth to 30 minutes
76
Heart rate in first period of reactivity
160-180 bpm
77
Respiratory rate in first period of reactivity
60-80
| Crackles may be present
78
After the first period of reactivity how long may the newborn sleep
60-100 minutes
79
How long is the transition second period
4-8 hours
80
Brief periods of what may happen in transition second period
Tachycardia and tachypnea, usually last only 10 minutes
81
Average newborn length
19 to 21 inches
82
Average newborn weight
7 pounds 8 ounces
83
SGA baby weight
Less than 5 pounds 8 ounces ( less than 10%)
84
LGA baby weight
Greater than 9 pounds ( greater than 90%)
85
Newborns can loose up to ___% of birth weight
10%
86
Normal newborn head circumference
33-38 cm
87
Normal newborn chest circumference
31-36 cm
88
A LGA baby may have a hard time doing what
Maintaining glucose
89
A SGA baby may have a hard time doing what
Maintaining temperature
90
Normal axillary temperature in newborn
97-99.5 degrees F
91
What kinds of breathers are newborns
Nose breathers
92
What respiratory patterns should you observe newborns for
Flaring, grunting, retracting
93
What should you ascultate newborns for? This is not an ok finding
Rales
94
What shape is anterior fontanel? When does it close?
Diamond shaped closes in 18 months
95
What shape is posterior fontanel? When does in close?
Triangle shaped and closes in 8-12 weeks
96
How should fontanels be
Open and soft
97
What do depressed fontanels indicate
Dehydration
98
What do bulging fontanels indicate
May be increased intracranial pressure
99
What colors are eyes? When does a permanent color establish?
Usually blue or gray. Permanent color establishes in 3-12 months
100
If red reflex is present what is intact
Cornea
101
How far can newborns see? Where is clearest vision?
Up to 2 1/2 feet. Clearest vision 8-12 inches
102
What may low set ears be a red flag for
Chromosomal abnormalities
103
What could bell shaped chest be a sign of
Undeveloped lungs
104
What shape should chest be
Cylindrical
105
What could unequal breath sounds be
Pneumothorax
106
What is present in umbilical cord
2 arteries, 1 vein
107
What does flat abdomen indicate
Diaphragmatic hernia
108
What is supra public area palpated for
Bladder distention
109
What could not feeling femoral pulse be a sign of
Coarctation of the aorta
110
In a term newborn what is normal for the female genital
Labia majora covers labia minora and clitoris
111
Newborns may have mucoid vaginal discharge due to what
Maternal hormones
112
How would you know if the anus is patent
If they have a stool
113
Can a hymental tag be present in a newborn?
Yes
114
When do testes descend?
By a year of Age
115
What should you check with male genital assessment
Placement of meatus
116
Is opening of penis is on dorsal surface
Epispadias
117
If opening of penis is on ventral surface
Hypospadias
118
What is present on scrotum
Rugae
119
Hyperflexibility of joints is associated with what
Down Syndrome
120
Test to assess for hip dislocation in newborns
Ortolani's
121
What do Simian creases suggest
Down syndrome
122
What is dimpling associated with
Spina bifida
123
What is normal sleep-wake cycle in newborns
45 minutes
124
Most common sign of pain
Crying
125
How can you tell intracranial pressure
By fontanel
126
What does the AAP recommend about infants and breast feeding
That they are exclusively breast feed for first 6 months of life
127
How long should breast feeding continue
At least 12 months
128
If infants are weaned before 12 months from breast milk what should they receive
Iron-fortified infant formula
129
Why is breast milk considered live tissue
Because it contains almost as many live cells as blood
130
How many lobes are the female breasts composed of? Why are in these lobes?
15-20 lobes embedded in fat and connective tissue, well supplied with blood vessels, lymphatic vessels, and nerves
131
How does the milk collect ebbing the nipple
Ductles enlarge into lactiferous ducts and sinuses
132
How is milk transported to the sucking infant
Nipple has 15-20 pores through which milk is transferred
133
How is prolactin produced
By infant sucking and emptying the breasts
134
When is prolactin highest
First 10 days
135
Do the breasts ever completely empty
No
136
What is oxytocin
Another hormone essential to lactation
137
What is colostrum
A clear yellowish fluid birth to 48 hours. It is more concentrated than mature milk
138
What is colostrum extremely rich in
Immunoglobins
139
When do you see transition milk? What are the characteristics?
48-72 hours
| High levels of fats, lactose, and water soluble vitamins. Higher calorie content. Larger volume
140
When is mature milk produced
By 10th to 15th day
141
What is percentage of water in mature milk?
90% water. Remaining 10% carbohydrates, fats, and proteins. More water maintains newborns fluid balance
142
What is the size of a newborns stomach? What about after 7-10 days?
Small marble can hold 5-7 cc's . After 7-10 days in increases to the size of a golf ball and can hold 1.5 to 2 ounces
143
How many times do newborns nurse in 24 hour time period
8-12 times
144
How often do newborns give cues to feed
Every 1-3 hours
145
What may result from poor latch on
Sore nipples
146
What does plugged milk ducts result from
Inadequate emptying or underwire bra. You should apply warm compresses prior to nursing
147
What is characterized by sudden flu like symptoms usually effects only one breast
Mastitis
148
Small raised white spots on the nose, chin, and forehead
Milia
149
Bluish purple spots of pigmentation. Commonly on shoulders, back, and buttocks
Mongolian spots
150
Should the head or chest circumference be larger?
Head should be 2-3 cm larger than chest circumference
151
Small whit nodules that appear on the roof of a newborns mouth
Epsteins pearls
152
How is the Moro Reflex elicited
By holding the newborn in a semi sitting position and then allowing the head and trunk to fall backward
153
Crackles and wheezing are symptoms of what
Fluid or infection In the lungs
